Prof Ann John: Prevention of suicide in young people in the COVID-19 pandemic and beyond

Professor Ann John is Professor of Public Health and Psychiatry, Swansea University Medical School.

The loss of any child through suicide is deeply painful.  Although suicide in young people is rare, with lower rates than in other age groups, rates have been rising in adolescents in England and Wales since 2010. Suicide is the leading cause of death in England and Wales for those aged 5-19 years old. Young people in their late teens have the highest rates of self-harm, a key risk factor for suicide. Self-harm has been rising in recent years, alongside anxiety and depression. A real worry is that the pandemic and the measures taken to curb the spread of COVID-19 will exacerbate and entrench these trends.

Young people will bear the brunt of this pandemic, despite their low risk of being affected by COVID-19.  That’s not conjecture, numerous surveys have consistently highlighted that the mental health of young people has been disproportionately affected compared to older adults and some point to an increase in self harm and suicidal thoughts. A recent report identified a possible trend that child suicide deaths may have increased during the first phase of lockdown in the UK, although studies in other countries found no change.

Suicide is not inevitable. Mitigation of the effects of the pandemic requires a recognition of how the risks of suicide for young people may be affected, often through known risk factors. Many young people continue to have their education disrupted. School and colleges are crucial places to engage young people- through their peers and trusted adults. They may be the only ‘safe place’ in the lives of children. For some, more time at home meant increased exposure to domestic violence, abuse, neglect, and high expressed emotion. For others, it meant a loss of agency, autonomy and independence at a pivotal stage of social development. Separation from friends, at the stage in life when peers are paramount, heightened loneliness and isolation for many. Some harmful behaviours, such as cyberbullying, online gambling and alcohol use, have escalated. Bereavements, complicated by separation, have occurred. Existing mental health issues may have worsened, coupled with poorer access to services- although for some they may have eased with reduced social and academic pressures. There is a high risk that young people will be particularly affected in the short and long-term by the economic recession with limited opportunities on leaving school, college or university.  Unemployment, financial stressors and deprivation are all linked to suicide.

Although the factors that contribute to a young person taking their own life are many and complex, suicide is potentially preventable. Risk factors for suicide can be addressed at a child, group or population level. This requires the collective action of individuals, communities, services, organisations, government and society. In much the same way as combating the spread of COVID-19 does.

Children and young people have been a focus for suicide prevention strategies, and this should continue. As the crisis evolves keeping schools open is a priority. We should tackle loneliness and enhance participation and prospects by guaranteeing that young people are supported in education, employment or work-based training (including pro-active retraining in hard hit sectors like hospitality), complemented by financial safety nets directed at them and their families.

We still don’t know how the pandemic and responses to suppress COVID-19  will affect suicide rates in young people but we do know that suicide is potentially preventable if we take action to mitigate those effects now. Let’s do it.